Friday, August 21, 2015

Euthanasia decisions are the hardest

A doctor who is reluctant to perform an assisted suicide but refers a patient to someone else prepared to do it, is on the same moral ground as a doctor who willingly participates.

The Supreme Court of Canada’s decision in February which struck down the ban on euthanasia prompted the Conservative government to form a commission on euthanasia last month.

One of the issues under debate is whether doctors should be compelled to perform assisted suicides on terminally ill patients.

In fact, it is absolutely crucial to determine who can influence the decision of carrying out a physician-assisted suicide.

The ethical and legal issues are complex.

Even deciding on a useful definition of “terminally ill” is a minefield, and that’s just the start.

Medical diagnosis and prognosis are inexact sciences, and mistakes in them often occur in Canada’s healthcare system.

Quebec’s Bill 52 right-to-die legislation, which has already passed, has been interpreted to mean the following:

To qualify as a terminal illness it must be incurable and serious; it must have caused an advanced and irreversible decline in bodily function; the person requesting the procedure must be in unbearable and constant pain, both physical and mental; the patient must be an adult, mentally sound enough to give credible consent.

As an extra safeguard, Quebec requires doctors and patients to get second opinions.

An independent commission composed of doctors, jurists, ethicists and ordinary citizens will oversee the process for reaching such decisions.

All the ground work seems to have been covered here.Suitable patients will be only those who are the truly terminally ill and anguished patients who can no longer live with their situation.

Given this, it almost seems humane to grant their wish of dying with dignity.

But do measures like this adequately address the concerns of doctors who object?

The large number of Canadian physicians reluctant to perform assisted suicides throws doubt on the practicality of such a policy.

Prominent Quebec bioethicist David Roy has noted that: “Killing the pain is the point, not killing the patient.”

He has also asked: “Should we socially and legally (put) this power to administer death to patients into the hands of physicians, who are relatively inept at communicating with suffering and dying people?”

I have stated the reasons for my unease about euthanasia previously.

My biggest concern is that suicide is self-evidently an irreversible decision for a patient to make.

Medical advances that could directly impact on a patient’s decision to take his or her life may be unlikely, but they are possible.

A disease that is “incurable” today may have a breakthrough in treatment tomorrow.

Recently, for example, researchers at Thomas Jefferson University discovered that blocking certain types of proteins in the brain may allow them to administer drugs that can inhibit Lou Gehrig’s disease (ALS) a debilitating illness.

It is hard to imagine an issue more likely to provoke polarized and heated arguments than euthanasia.

Any law which tries to define its limits will face challenges not just from doctors, who are on the front lines of medical care, but from all sections of society.

The debate is much wider than the example of any single case.

No law is likely to be fair and comprehensive enough that it will address all concerns about allowing euthanasia as one humane option in genuinely dire cases.